Client Intake Form

Vet Client Intake Form

Vets, please complete this form for your client for our cremation services.
Date*

MonthDayYear
Date
Vet Office Business Name*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Requested By*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Is Pick-Up Location at Your Office?*

YesNo
If No, Please Provide Pick-Up Location
Pet's Name*
Breed*
Owner's Name*

First NameLast Name
Vet's Client ID
Weight of Animal in Lbs.*
Date of Birth
Date of Death
Cremation Type*

PrivatePartionedCommunal
Urn Selection - 1st Choice - Indicate Item Number (If no urn, please indicate with N/A)*
Urn Selection - 2nd Choice (if 1st Choice is not available) - Indicate Item Number
Would You Like the Name of the Pet on the Urn? (Note: There is No Extra Charge for Name)*

YesNo
Additional Inscription on the Urn ($1.50 per Character)
Clay Paw Print

Note: If no style is listed, the outline of the paw print will be the default.
Style Paw Print
Indicate Style Number
Color Note: White is the default color unless you request another color. One color is standard, but if two colors are requested, there will be a $5.00 fee for the additional color(s).
Color Requested
Additional Instructions
Specialty Urns or Custom Plaque

If the client requests a picture frame urn or a custom clay paw print plaque, they can email the picture to heavenlypetscremation@gmail.com.
Should be Empty:

Vet Client Intake Form